Furman S. McDonald, MD 00:00:00 I think the future is very bright for internal medicine, and for all those med students out there that are looking to get their match lists in internal medicine is a great place to put them, and we think there's a bright future for them there.

Keith Reynolds 00:00:20 Welcome to Off the Chart with Medical Economics, a podcast featuring lively and informative conversations with health care experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. I'm your host, Keith Ronalds, and today we feature an interview between Medical Economics editorial director Chris Maslin and Doctor Fuhrman. S MacDonald, incoming president of the American Board of Internal Medicine. They're discussing his background, his plans for leading the organization, and the evolution of the medical certification process.

Christopher Mazzolini 00:00:56 Doctor Furman MacDonald, thank you so much for joining me today.

Furman S. McDonald, MD 00:01:00 Chris. delighted to visit with you.

Christopher Mazzolini 00:01:03 So to start off, can you tell our physician audience a bit about your background, your professional background?

Furman S. McDonald, MD 00:01:09 Professional background? So I think, I would probably bucket that. So I have a background in science.

Furman S. McDonald, MD 00:01:16 So I, I started out in physics, as an undergrad, moved into medicine, and then my career turned into graduate medical education, with a focus there. And so a research career focused on, graduate medical education, especially in internal medicine, would be, my time prior to, ABM. And I could hit buckets there if you wanted, or that would be the that would be the first sentence of the elevator speech.

Christopher Mazzolini 00:01:40 So yeah. So tell me a little bit about, sort of like, taking on this new role at ABM. What priorities you have. where would you like to see the organization go during your tenure? Those sort of things.

Furman S. McDonald, MD 00:01:55 So I'm excited to be working with ABM towards meeting its mission. what is it focusing on? The mission of ABM is to certify internists and subspecialists who demonstrate the knowledge, skills and attitudes essential for excellent patient care. And I've always said the most important word in that mission statement, Chris, is not certify. It's demonstrate. And so ABM will continue to work towards that goal because that goal has consequences.

Furman S. McDonald, MD 00:02:23 And that goal has, positive outcomes for patients. We're of the profession and for the patient. So I see ABM being, continuing to be an even more so, a vehicle by which the profession set standards for itself. And to do that, we have to listen. We have to actually listen to the profession moving forward. So I'm especially early on going to be, spending a lot of time hearing what our diplomats and those practicing and internal medicine and its subspecialties have to say.

Christopher Mazzolini 00:02:53 Yeah, obviously, maintenance of certification, I'll probably call it MOC going forward, is always a topic of interest to internal medicine physicians or really physicians of any specialty. but but we're talking about Im docs here. So can you tell us a little bit from your perspective why maintenance of certification remains important for physicians here in 2024?

Furman S. McDonald, MD 00:03:15 absolutely. So remember that mission statement is around demonstration. So it turns out, Chris, there is a large and growing body of evidence that patients whose doctors, demonstrate more medical knowledge have a better prognosis on a host of outcomes.

Furman S. McDonald, MD 00:03:32 And that was published that was published in Jama, recently as part of our board of directors perspective piece. There's a huge amount of evidence that backs that up. So, I'm excited about extending that evidence base. I'm excited about working with physicians in an evidence based manner to achieve the best outcomes, the best prognosis for our patients, because ultimately, the patient is at the center of what we do as physicians. ABM is of the profession for the public. and and that's a wonderful place to be because doctors and patients want the same thing. They want, better outcomes for the patient.

Christopher Mazzolini 00:04:10 I know that the the the mock process, there's been evolutions to it as we've gone through the years. So can you tell us a little bit about how that process has evolved recently and how it may continue to evolve in the future? I'm sure doctors are always sort of wondering about what's going to be changing. And so is there any, any changes that they need to know about right now?

Furman S. McDonald, MD 00:04:32 I'm not so sure.

Furman S. McDonald, MD 00:04:33 There's been a lot of change. You're you're you're very right. There's been a lot of change. And so much of the change at ADM has actually been streamlining, removing requirements actually over the last ten years. lowering the cost of, of certification, of maintenance of certification for all of our diplomats who utilize the longitudinal knowledge assessment. And then, and then the advent of the longitudinal knowledge assessment. So doctors don't have to go to a Pearson Vue center. They don't have to take a full day exam if they don't wish to, to demonstrate their knowledge. So those have been really positive, points of evolution. and you should anticipate that, that that will continue. So with the longitudinal knowledge assessment it is an assessment. Right. So we're not getting away from the importance of assessment, but it also has formative learning components to it. and a lot of doctors seem to like that. So so we are excited about the 80% of people who are choosing the longitudinal knowledge assessment right now. there will be improvements to it as we go along.

Furman S. McDonald, MD 00:05:35 We'll continue to evolve it, as we hear what people will find most helpful. and we will study it. Chris, I want to I want to make it clear we will be studying the, the outcomes of, associated with the use of that, maintenance of certification aspect.

Christopher Mazzolini 00:05:53 to broaden the discussion a bit, one of the one of the sort of broader societal challenges that that we've noticed is that there's been a declining trust in institutions across the board. you know, government, the media. you name it, it seems like trust is declining. one thing we've always heard, and medical economics, is that patients still have a huge amount of trust in their doctor, but at the same time, patients trust in the larger sort of anonymous health care system has been sort of eroding. so how do you think like, and what is the role of ABM in preserving that trust that that trusted relationship that patients have with their doctor? while, you know, trying to trying to help sort of bolster the health care system as a whole.

Furman S. McDonald, MD 00:06:40 Yeah, I was I was reviewing a survey in Jama recently, just promoting just what you said, that the patients actually have a lot of trust in their doctors and, well, they should because doctors expertise matters. So ABM is actually right in line with the physician there because our credential actually, supports in the, That the expertise of the practicing physician. So it's actually a marker of that. and, and I think one thing that will continue to help, maintain the trust within the physician is, is, is that promotion of their expertise.

Christopher Mazzolini 00:07:21 one of the other, issues that's been, sort of out there in medicine is, sort of a historic lack of diversity among physicians. what do you think is the role of sort of the very specialties to try to increase the diversity of that specialty? And and what role do you think, ABM has in that?

Furman S. McDonald, MD 00:07:43 Yeah, it's a great question. It's an important area. There's there are decades of research around, potential improvements and care based on diversity of health care providers.

Furman S. McDonald, MD 00:07:52 you know, ABM certification happens at the end of the pathway of training, right? So after residency and, and and to get to that point, there's high school and college and medical school and residency. That isn't to say that maybe I'm is, should not, focus in this area. And indeed they have the board has actually, made commitments to diversity, equity and inclusion. And in fact, if you look at ABM governance, the ABM Council, put forward an aspirational goal to have ABM. It's the governance of ABM to reflect the diversity of the population, not necessarily the patient, the physician population. So the diversity of the patient population for the physician population. And we've made great strides towards that. and if you look at ABM governance right now, you'll see it's actually, not arguably it is more diverse along a lot of metrics than, than just the underlying, physician population. So I think there's a lot we can do there. You know, diversity is not just about it is a lot about who's at the table.

Furman S. McDonald, MD 00:08:54 And that's important. That's about bringing people into the process. it's also about, equity, about treating people fairly and avoiding bias and abm's doing a lot of work there to ensure that its assessments, are analyzed for bias and, if present, removed.

Christopher Mazzolini 00:09:10 Another issue is burnout. It's one we've been hearing about a lot, especially in the wake of the Covid 19 pandemic. how do you how do you see the approach to confronting this challenge, and how has it changed over the years? And what are some ways that we can we can lessen the burden for practicing doctors. You know, you had mentioned, sort of like sort of like listening to the diplomats and the the folks within the IAM specialty, you know, what kinds of things do you think ABM can do to try to sort of have a role in improving clinician burnout?

Furman S. McDonald, MD 00:09:44 Well, that's a big problem. Clinician burnout. And it's that's a lot. Again, a problem of larger scope than ABM will be able to fix alone. However, we certainly can be part of the solution.

Furman S. McDonald, MD 00:09:55 You know, it's interesting, Chris, a lot of the, a lot of the literature about burnout came out of the Mayo Clinic with friends of mine who are doing some of that work. Shannon felt now has moved on. Lottie Darby, Colin West Colin West was associate program director at Mayo when I was there. So I have some insight into this literature. and, and in fact, I've studied burnout in the program. Director of population, I encourage you to look at some of our, Association of Program Directors of Internal medicine literature on, internal medicine residency program director burnout, where it is prevalent but not as large, in number as as as the practicing physician and their their components to burnout. Part of it is, it's, you know, people focus on how much someone is working in total amount of time, but it turns out that it's probably less about total time and more about how much control you have over what you're doing. Right. And, and and if one gets into, work life balance, conflict, are you able to resolve that in a way that promotes both work and life And that's where I think our physicians are being challenged today with the electronic medical records and the amount of time they're spending after seeing the patient, or the amount of time they're being kept from doing the thing they want to do, which is see the patient.

Furman S. McDonald, MD 00:11:12 I think it's a it's a real challenge for every internist, not just internist, but physicians today. So we're we're can abi and be part of this. We certainly are listening to what our, our diplomats are saying. We're giving them autonomy and control over the way they seek their assessments. They're getting options now. They don't. Everybody doesn't have to go to the Pearson Center. You can choose to do it in another way if you wish, and promote their expertise, because a doctor who is able to deliver the best care to patients is that is in itself an antidote to burnout. But ultimately, there's some health care system changes I believe they'll probably have to occur, and ABM can be there. with the House of medicine, in in discussion around these areas, even if we're not the one who's going to make, you know, be able to pull the lever that fixes all things about the health care system that are promoting burnout right now.

Christopher Mazzolini 00:12:06 Yeah, definitely. the other hot button issue right now is AI, specifically the large language models that, you know, I think most people recognize ChatGPT, but, you know, Google has AI answers.

Christopher Mazzolini 00:12:19 There's a lot of AI tools out there, and a lot of our physician readers are wondering about the role AI has in medicine. There's everything from, you know, sort of the science fiction thing of, you know, I will be diagnosing patients all the way down to using AI to help with writing emails to patients and doing some of those practice management, tasks. What you know, this is obviously an area that is fast developing, and the the future is sort of uncertain here, but but what role right now, you know, based on like the current, you know, existence of these things, do you think that AI has and sort of in medicine in general.

Furman S. McDonald, MD 00:12:57 That's a big, broad topic. and I'm actually kind of excited About. a I'm not afraid of AI as a physician. and I will tell you, many people don't know this, but the American Board of Internal Medicine, the board of directors, before ChatGPT was launched, was in a strategic conversation for some time and came to the conclusion that understanding the emerging technologies that are affecting healthcare, in particular artificial intelligence, were things that we should be focusing on and looking out for.

Furman S. McDonald, MD 00:13:29 So they were prescient in that sense. and so I think the things that you just mentioned were the immediate, most helpful, maybe in those administrative tasks that, that, that, that they can help, the physician with, if, if there's anything out there that can help documentation and take the burden of documentation that's going to that's going to make, especially internists and subspecialists of internal medicine, that's going to help them be able to spend more time in front of the patient. I think anything that can help us spend more time in direct connection with our patients. That's a positive. And those will be good. In the assessment realm. There's there's great hope that these technologies May 1st day allow us to better assess, the competencies that currently are difficult to assess, like communications, for instance, and artifacts of care are being created every day. which in the past it's been challenging to process them and to be able to give the doctor feedback on them in a way that could help the physician in their practice.

Furman S. McDonald, MD 00:14:34 But I, in emerging technologies, may be able to help us do that. Do I know how to do all that? No, I don't know how to do it. But I'm looking at these technologies emerging and and seeing actually great promise. I'm not seeing something that's. Look, if we get to the day where you don't need a doctor because everybody's healthy and I can take care of us all. Great. Okay. I don't see that coming anytime soon. And when every technology has come out, it's usually been the more knowledgeable physician who's been able to actually utilize the technologies better. So, you know, the statement that's out there that AI is not going to replace doctors, but doctors who use AI may replace doctors who don't. Maybe that'll be the case in the future. So I'm looking at this. And with every technology that rolls out, it's bumpy. And and and I think we do need to take cautions from history. You know, was it Bill gates that said if you if you have a system that's not working well when you apply technology to it, it'll amplify the things that aren't working.

Furman S. McDonald, MD 00:15:33 Well, we don't want to be in that situation. Right. So we need to, be looking at how do we help, use these technologies to help improve the system and then at a time, to help improve assessment.

Christopher Mazzolini 00:15:45 Last question. Is there anything we didn't discuss that you think it's important to mention about ABM or anything else to our physician audience?

Furman S. McDonald, MD 00:15:55 We reiterate that at least I coming in, I think ABM in general, but we are really a vehicle by which the profession set standards for itself. And so to do that, we have to hear from the diplomat. And a lot of work has gone into that. I will tell you, we're moving into hearing even more from our early career physicians and the people coming in this transition from residency to fellowship to, to practice. So there's going to be a lot of, a lot of listening there. I'm actually excited. I'm excited not just about the new role. I'm excited about internal medicine and about its subspecialties, this discipline and, and these disciplines, really, it's 20 subspecialties, right? in addition to core internal medicine, this, this profession has always epitomized the highest goals of medicine in the United States and elsewhere.

Furman S. McDonald, MD 00:16:48 And I think the future is very bright for internal medicine and for all those, med students out there that are looking to get their match licenses in, internal medicine is a great place to put them. And we think there's a bright future for them there.

Christopher Mazzolini 00:17:01 Doctor Furman McDonald thank you so much for joining me today. I really appreciate appreciate your time and your insights.

Furman S. McDonald, MD 00:17:07 Chris, thanks so much for having me. I really enjoyed talking to you.

Keith Reynolds 00:17:18 Again, that was medical economics editorial director Chris Maslany and Doctor Fuhrman S MacDonald, incoming president of the American Board of Internal Medicine. My name is Keith Reynolds, and on behalf of the whole medical economics team, I'd like to thank you for listening and ask that you please subscribe to the show on Apple Podcasts and Spotify. And don't forget, if you'd like a digest of the best stories Medical Economics publishes delivered straight to your email six days a week, subscribe to our newsletter at Medical economics.com.